If nothing else, I certainly found writing this cathartic, and it is something Eli can read for himself someday.
We took Eli to Urgent Care on Wednesday afternoon. He has been struggling with constipation lately. I think he starts out by holding it in, because he is potty training and 3 and stubborn and he doesn't want to go. Then, everything backs up and it becomes hard and painful for him to go so the problem reinforces itself. At Urgent Care the doctor explained how normal toddler bowel impaction is and said we would get it taken care of. The x-rayed him and that's where the trouble began. The x-ray showed large masses in his colon/abdomen and the Dr. was concerned. She called a radiologist colleague and they discussed it. They did more x-rays. They showed us the x-rays and pointed out their concerns. They were very grave. The Dr. said many things, in one of those Dr monologues they do. Of course the things that stuck out to me were blah, blah "tumors can present with constipation" blah, blah and blah, blah "the kind of tumors we would be concerned about would be malignant" blah, blah and blah, blah "then, we would be concerned about staging" blah, blah. Derek and I still felt the most likely explanation was very impacted stool, but you cannot hear the words malignant and tumor in a conversation about your child and not freak out at least to some extent.
So, we went down to Children's ER. Urgent Care told us we could drive our car, we did not have to take an ambulance. This is the state in which we were suddenly operating. It was about 8:00 pm. They needed to do a CT scan to visualize the "masses" better. They put in an IV. We needed to get Eli to drink about 10 fl oz of apple juice with the CT contrast stuff in it. He didn't want it. We used one of those baby droppers that hold 2 tsp at a time. Every single sip of every single dropper was a battle to get in his mouth. He fought and fought and fought. If I ever doubted it before, I certainly learned that my son is STRONG. There is no pushing this little guy around. He was tired and had been examined and poked too much. It was now 10 pm and past his bedtime. He was pissed. It took us 1.5 hours of fighting with him to get it down. We essentially forced it down his throat one squirt at a time. At one point he gagged badly and threw a little of it back up, but we didn't tell the nurse that. It took about 20 droppers full. Derek and I decided at one point that every time I filled the dropper up, the glass was actually getting fuller instead of emptying. In that moment of dark, overstressed, adrenaline fueled humor we discussed the new religion that we will be founding centered around this miracle. We couldn't decide definitively what our menorah-like symbol will be, but we have some first drafts. I already warned Heidi in a text that the proselytizing will begin once we get a little more caught up on sleep.
The CT scan dispelled the tumor concern, so we were back to just a severely impacted bowel. That was a huge relief. They admitted us at 2:00 am and we went through that bullshit process. I'm there with a nurse trying to get Eli to stand on a scale at 2:30 am with everything he has been through already. He didn't want to do it or trust her one bit. The nurse leans over and sternly corrects him, right up in his grill. "Buddy, buddy, BUDDY. You have to stand on the scale." I wanted to punch her in the neck. I didn't. How badly does she need a weight at 2:30 am anyway?
I answered all the admitting questions for the night resident, barely concealing my vitriol over giving the same story for the fifth time to a doctor who I would probably never see again. When did he last poop? How often does he usually poop? Was he complaining of a stomach ache? He didn't tell you his stomach hurt specifically? (Eli isn't a big talker) Was he crying alot? How did you know he was in pain? Listen dude, a mother just knows, OK. Then all the social history type questions. Why does he get speech therapy? What other therapies? Was he a preemie or something? No? I didn't think a 3 year old boy with a speech delay was such a rarity. All this time (and it's now 2:50 am), Eli was sitting on the hospital bed glaring at the doctors silently, only saying an emphatic "NO!" anytime anyone spoke to him or looked like they might possibly touch him. The doctor at one point asked me, "Does he ever talk, like at all?" Sure he does. He talks all the time. To me. I wouldn't count on him talking to you right now, though.
While I'm on that subject, at one point during the night I mentally composed the following...
An open letter to the nurse who was so openly exasperated by my uncooperative toddler when she tried to check his vitals at 5:30 am.
Hello,
You asked (outloud) "What's the problem, honey?" but you clearly with your tone meant, "What's your problem, little brat?" to my 3 year old son who was screaming while you tried to check his blood pressure. Allow me to enumerate the problems that he had at that moment.
1. He is 3 years old.
2. He was awakened from a deep sleep to see you (a stranger) leaning over him and a big thing squeezing his arm tightly.
3. It was 5:30 am and he had only been sleeping since 3:00 am for that whole night.
4. He had spent the previous day being forcibly restrained while needles were poked in his veins, liquid was forced down his throat, and foreign objects were shoved up his butt (TMI maybe, but true).
5. He is 3 years old.
6. He hasn't pooped in a week, hasn't eaten in over a day and hasn't had anything to drink in over 12 hours (not counting the liquid forced down his throat) and he is really uncomfortable.
7. He is in a strange and pretty scary place.
8. He is 3 years old.
Lay off him if you know what's good for you,
Sincerely,
his Mom
Day 1 in the hospital was mostly waiting around. Very typical for hospitals when you do not have an emergency. We were told we would be seen by the GI rounds, but then they skipped us. The resident said we would go ahead with the cleanout. It's essentially the same thing they make you do before a colonoscopy. You ingest large amounts of liquid and laxative and wait. After making this plan at 8:00 am, the medicine didn't arrive from the pharmacy until 2:00 pm. The process takes 6+ hours, so there was no way we were going home that day. We were told that our pediatrician would come by to see him, but she never did. I think she called in and left a note for the resident. She never spoke with us.
A 3 year old can't drink enough liquid fast enough to do the cleanout on his own. The first one was 32 fl. oz. The second cleanout was even more than this (I calculated around 45 fl. oz.) We were told by several people Eli would get an ng tube (up his nose, down his throat and into his stomach) for the liquid. Our nurse when the time came (named Derek, actually) really seemed to want us to get Eli to drink it in a cup. We tried to tell him it wouldn't work. He couldn't understand why we would want to subject our son to a tube pushed up his nose. We just knew it wouldn't work. He tried several times over the course of an hour or so to convince us not to do the ng tube. The resident pediatrician, on the other hand, seemed to assume that it would be the tube right off the bat. We went several rounds between the resident coming in and Derek the nurse before building a consensus on the ng tube. I did offer Eli the first 8 oz in a cup and he wouldn't touch it. There was no way.
Two big strong nurses wrapped Eli up and Derek the Nurse put the tube in. We unwrapped Eli and I picked him up and he reached up and ripped it right out. So, he went back on the table and they put another tube up the other nostril. During the kerfuffle over the second tube, Derek the Nurse partially ripped Eli's IV out which started bleeding all over the place. So the IV came out (another was put in later in his other hand). In between tube attempts, Derek (the Dad) arrived back at the hospital and came in to help. I said something to him to the effect of "I really tried to get him to drink it," because Derek the Nurse had made me feel so guilty for subjecting my son to this ordeal because I couldn't get him to drink Gatorade out of a cup. The other male nurse who was helping with the restraining said immediately, "oh, they all wind up here. Parents always think they can get their kids to drink all of it, but they can't. We always do the tube eventually." I avoided making eye contact with Derek the Nurse, because I didn't think giving him the stink-eye would be helpful in this moment.
Once the tube was in and taped, Eli accepted it and probably forgot it was there. At one point much later, I made the fatal mistake of walking past the mirror in our room while holding Eli. He looked in the mirror and saw the tube and tape all over his face. The look on his face was epic. A combination of total shock and pure rage. I quickly distracted him and at least he let it go.
Around 7:00pm, it was obvious that the first cleanout had partially worked but was clearly not going to be enough. This is when the combination of adrenaline which kicked in with the tumor scare and had never really died down coupled with the 1.5 hours of sleep and my annoyance with the hospital crap all sort of combusted. I lost it a little bit. We tried to understand what the next steps would be and what we would do if the cleanouts didn't work. We got a variety of answers, but mostly we got totally brushed off. The resident was clearly passing us off and telling us that it was our pediatrician who called the shots, but we had never heard anything from them. We paged the ped. on call and he got to talk to a version of myself that I barely recognize.
Here's a few things about me. 1) I am genuinely a fairly calm, rational person. I am frequently described as "easy-going" by people, many of whom know me very well. I think of myself as more a fretter, at least sometimes, but I guess at some point I realized that at the very least the fretting is obviously not on the outside. 2) I come from a long, multigenerational line of professional under-reactors. Emotional repression is my birthright, and I own it. 3) I am pathologically non-confrontational. These things make me the hospital's favorite kind of patient. I am that person who sits quietly in my room all night, not making a peep or, god forbid, pressing the call button (perish the thought), and then in the morning finds myself nodding and making sympathetic noises while the nurse who neglected to bring me my pain medication for the entire shift vents to me about her troubles. True story (she did bring in several bagfuls of free formula samples to take home with Eli to ease her guilt). The person on the phone with Eli's pediatrician at 7:30 Thursday night was not this model patient. Yelling through tears, especially at a semi-authority figure, is uncharted territory for me but there it is.
The pediatrician was very patient. He shared my concerns about the hospital's non-responsiveness. He sloughed off the fact that the other doctor from their practice blew us off, however. He was the one who introduced the idea that Eli might need surgery (a manual disimpaction isn't major surgery, but it is done in the OR under anesthesia so it would come under the purview of surgical). He expressed concern that it would be hard to react fast enough to get the surgery on the schedule Friday afternoon and there was no way it would be done over the weekend. It just wasn't that serious. So now we are thinking we might be stuck in the hospital all weekend, or faced with the choice to take Eli home (with or without the hospital's blessing) and try to set something up from there.
My fit throwing did get some results. They decided to do the second cleanout overnight instead of waiting until morning. They scheduled us for an xray at 6:00 am - we were the very first people there when radiology came in. We were assured that we were on the GI rounds for the morning. We were skeptical, but didn't have much leverage.
We settled in Eli around 11:00 for the night. The second cleanout was to go from 10:00 until 2:30 am. He basically slept through it, which was good. The nurse and I did a complete pajama, bed sheet change twice during the night, but he hardly woke up for it. Of course, we got the pediatric nurse with a poop-phobia for this night. You're a pediatric nurse! I would think poop is an occupational hazard. She kept trying to convince me to essentially wrap the baby in layers of garbage bags head to toe, but I really wanted him comfortable enough to sleep so we compromised.
We approached Day 2 under the active assumption that every single person involved was either lying to us or blowing us off. We didn't make too many friends, I don't think. We paged the pediatrician's service to make sure the doctor was coming to see us first thing. We were told she would be the one who could make things happen if necessary. She did come in around 8:30 and so did the pediatric resident. GI skipped us again, despite everyone's assurance that they wouldn't. Dr. London talked me off the ledge, somewhat patronizingly but I can sympathize with her viewpoint. After another night of 1.5 hours of interrupted sleep, I wasn't that pleasant. Everyone was really convinced that the second cleanout would work, or at least the hypothetical third cleanout would. We didn't want to consider a third cleanout. The xray showed he was really cleaned out, which was really good news. It got better from there.
One reason Dr. London had to talk me off the ledge was that she gave us some information which finally made sense and which apparently everyone had known all along but no one had shared with us. So I think they are partially to blame for how panicked we were and our possible over-reaction. It's like, once they knew the patient was going to be okay they moved on to the next, more pressing patient, but they never bothered to explain to us what the process was going to look like. Again, I imagine this would have been our pediatrician's role, and Dr. London was the third one of the doctors from our practice to have been consulted on Eli's case. So while I appreciate why she took the "there, there" approach with me, I am somewhat defensive about the fact that I had been left in the dark on many factors up until then (and had a cancer scare and very little sleep on top of it).
GI finally came by and talked with us. After being told over and over by everyone else that GI were the decision-makers, the nice GI resident kind of said, "oh, they can release you whenever. We don't make that call." Okaaaay. We tried to keep the wheels moving and we were released early afternoon. In the end, it was only a 48 hour ordeal, which is pretty short in hospital-time. It was a very long 48 hours, is all I can say. In hindsight, it already looks like not that big of a deal, all things considered. Eli is fine and in good spirits, which is what really matters. We have a plan going forward to make sure he avoids this happening again.
To finish the saga, I just have to say that there is a special circle of hell that is being in a hospital with a non-emergency but highly unpleasant condition. I have to check with Dante to see what one does in life in order to be consigned to this particular circle. Whatever it is, I need to be sure that I don't do it. I have always said that my own personal circle of hell would be eternal cross-country skiing and photocopying. I have been saying that for about 20 years (probably since I had to read The Inferno in my freshman literature class). At some point, they vastly improved the convenience and usability of copy machines, so I switched it to eternal cross-country skiing and bottle return. Being in a hospital with a non-emergency is several circles below this. And obviously when it is your child that is suffering, it is the worst feeling in the world. There is the requisite, perspective-keeping observation here that of course there are many, many things that are so much worse than anything we came close to having to go through, and we were always so incredibly thankful, even at the lowest moment, that Eli was going to be okay. We're just so glad to have our boy home.
I took some iPhone pictures throughout the hospital stay. They are kind of sad to look at, but they definitely represent the experience to me.
Here is Eli in the ER. I didn't mean to capture this expression. The iPhone has a long shutter delay which I am not used to from shooting with an SLR most of the time. With the delay, you get whatever expression you get, not the one that you saw right as you pressed the shutter. Eli was pretty much making this face continually, however, so there wasn't a real good way to avoid it.
Eli with his IV in, waiting around.
Eli on day one of the hospital stay, playing in the hospital playroom.
Thursday night. He is tucked into bed, hooked up to his IV in his hand and the tube in his nose. He's not sleeping here, he's watching TV. Very pathetically.
Eli sleeping on Friday morning, from my vantage point on the parent foldout bed. There was killer light in our hospital room. Under better circumstances I would have been thrilled.
Eli an hour or so after coming home. You can see how his tummy is still pooched out from all the liquids they pumped into him. He's got Thomas the Train, his Yo Gabba Gabba underwear and his knee pads. He's a happy boy. (You can also see his pink toenail polish. He did that himself earlier in the week.)
